Youth Workers ’ Role in Engaging Youth in Health Advocacy for Community-Level Change

Youth development professionals and volunteers, here referred to collectively as “youth workers,” need to be prepared to engage young people as health advocates. Youth workers need an understanding of public health principles; policy, systems, environment change approaches; and effective youth–adult strategies to move from viewing youth as participants to engaged leaders in community health issues. Embracing youth as partners will create effective partnerships and yield substantial positive health impacts for the youth, adults, and their communities.

The need to address the nation's worrisome health indicators, including lack of physical activity, mental health status, and overweight and obesity, is clear (Millstein & Sallis, 2011).The obesity rates for youth 6 to 19 years (near 20%) and for adults (40%) (Hales, Carroll, Fryar, & Ogden, 2017) are indicators of increased risk for many diseases and health conditions.The national suicide rate has increased 30% over the past 10 years (Hedegaard, Curtin, & Warner, 2018).
Just over half (52%) of adults meet the physical activity guidelines for aerobic physical activity and only 22% meet the guidelines for both aerobic and muscle-strengthening activity (Clarke, Norris, & Schiller, 2017).These sample indicators suggest that youth and adults are experiencing mounting health issues.Current public health research supports strategic, coordinated interventions for health promotion (Bleck & DeBate, 2016;Edwards & Cheeley, 2016;Jayaratne, Bradley, & Driscoll, 2009).
Communities are addressing health issues from multiple perspectives and engaging various partners to effect change.Although they are often left out of the process, youth have a role to play in advocating for changes in policies, systems, and environments (PSE).Youth can be successful when they have support from youth development professionals, leading to positive changes for the whole community.
Positive Youth Development for Health (PYDH) refers to conditions and actions that support young people to develop into competent, caring, and contributing adults while experiencing physical, social, and emotional well-being.Integration of public health principles into youth development efforts to promote healthy behaviors using PSE change approaches may enhance PYDH efforts (Besenyi et al., 2014;Brownell, Schwartz, Puhl, Henderson, & Harris, 2009;Fitzgerald & Spaccarotella, 2009;Smathers et al., 2018).Based on the social-ecological model that elucidates the complex influences of multiple factors across multiple levels (Sallis & Owen, 2015), youth can use PSE change approaches to advocate for health at the individual, interpersonal, community, policy, and system levels (Franck, Donaldson, Toman, & Moody, 2014;World Health Organization, 2017).
The Cooperative Extension System (Extension) is uniquely positioned to provide an integrated, holistic approach to community health that uses PSE health approaches at the community level.
Extension serves as the outreach arm of land-grant universities across the United States.
Extension brings knowledge gained through research directly to the community using nonformal education strategies to create positive change.
Extension's Committee on Organization and Policy established health action teams in 2015 to address the strategic program priorities and achieve associated outcomes identified in Cooperative Extension's National Framework for Health and Wellness (Braun et al., 2014).As members of Extension's PYDH Action Team, we compiled resources, trainings, and best practices for equipping youth-serving professionals and volunteers to expand their capacity to create a culture of health for youth.Our team's work reiterates the importance of preparing youth development professionals and volunteers, referred to collectively in this article as youth workers, to engage youth as advocates for health in their communities.Youth workers provide pathways, opportunities, and organizational structures that maximize ways young people can uniquely influence changes in social and physical environments and policy realms, while benefiting from increased skill development and well-being.Youth-serving organizations, such as 4-H, provide resources and support functions that promote youth workers' readiness to support and encourage youth as advocates for health.

Youth Advocates for Healthy Living
Advocacy refers to the process of increasing support for, recommending, and arguing to promote a cause or policy (Carlisle, 2000).It involves education, skill development, and behavior and attitude changes with the goal of persuading others to act (Millstein & Sallis, 2011).A survey of states' 4-H teen health ambassador programs indicated that programs use "ambassador" or "advocate" to describe teen leaders who are teaching others and delivering healthy living programs (Ferrari, in press).However, although giving youth opportunities to learn and share their knowledge is a common practice in such programs, advocacy goes a step further.Youth in the health advocate role have the potential to identify health behaviors, formulate and implement action strategies, and generate substantial positive impacts for themselves and their communities (Smathers & Ferrari, 2018).Youth advocates are empowered through training, establishing youth-adult partnerships, building a knowledge base, practicing skills and behaviors, and increasing awareness of issues (Andrade et al., 2015;Arnold et al., 2016;Millstein, Woodruff, Linton, Edwards, & Sallis, 2016).
When young people are provided with support to be advocates, such as education, training, and coaching, they can better influence changes in policies, systems, and environments in unique ways, while also benefiting from increased skill development and well-being (Millstein & Sallis, 2011;Scheve, Perkins, & Mincemoyer, 2006).Extension youth advocate programs are conducted within a youth-adult partnership model in which informal or formal relationships between youth and adults are designed to foster equity between partners (Murdock & Paterson, 2002).Models such as youth participatory action research engage youth, who could be impacted by potential changes in communities and environments, in identifying, planning, implementing, and evaluating the change interventions themselves (Louie et al., 2017;White, Shoffner, Johnson, Knowles, & Mills, 2012).
Youth advocacy is not without challenges.The advocacy process can be slow, and, if youth and youth workers are only able to commit limited time to the effort, desired changes may not come to fruition.The process of youth professionals working with youth health advocates usually takes more time and effort than when youth professionals deliver direct health education (Louie et al., 2017).Youth professionals may best recruit new youth advocates by encouraging teens to connect with current and new friends while providing them peer support and social or shared experiences.They will need funding across years or cohorts to sustain project impact or build on prior efforts (Arnold et al., 2016;Millstein & Sallis, 2011).

Health Advocacy
Youth workers can go beyond promoting a young person's development in typical ways (e.g., supporting academic success, reducing risk-taking behaviors, increasing positive health attitudes) (Borden, Schlomer, & Wiggs, 2011) to providing social and physical environments that support healthful behaviors and effectively guiding youth who want to advocate for healthier communities.To better support youth as health advocates, youth workers can look to many existing PYDH competency-building resources (see Table 1).

Call to Action
For greatest impact, responses to public health issues must go beyond influencing individual behavioral change.Youth advocates can elect to help prevent disease or injury by addressing environmental, legislative, and systematic concerns, while promoting and encouraging healthy behaviors and mental well-being at a community level.However, due to identified challenges of time and availability of youth and adults recruiting youth, and securing funding (GENYOUth, 2016;Millstein & Sallis, 2011), youth advocates need the support of qualified youth workers to ensure effectiveness, success, and sustainability.Youth also need to see adults "practice what they teach" by providing the environment for change (Smathers & Lobb, 2018).Therefore, youth workers have a responsibility to build their own competence and understanding of PSE to affect change at numerous levels to work in partnership with youth advocates.
The first step for youth workers is to explore and use available competency-building resources to engage youth health advocates (Table 1).Youth workers already partnering with youth health advocates can play a critical role in advancing youth as engaged leaders in community health issues.By sharing their knowledge and experiences of PSE change approaches within the youth-adult partnership context, they help prepare other youth development professionals, volunteers, and external organizations to engage youth health advocates (Millstein & Sallis, 2011).Youth workers must be willing to understand and change their approach to engaging youth by adapting to the environments youth are functioning in rather than expecting youth to be available and interested in adult-driven agendas and schedules.Building on the social ecological model and working within existing systems, youth workers can engage schools to incorporate youth health advocacy into the curricula (GENYOUth, 2016).An outcome to strive for is empowering youth to use their own voices advocating for and creating community change.
Ultimately, youth workers who interact with youth as colleagues, when appropriate, in health promotion and advocacy create a partnership that supports empowerment.Contribution to such teams is determined by interest, time, skills, and networks of each individual and may be an evolving process (Zeldin, Bestul, & Powers, 2012).These interactions potentially will yield substantial positive health impacts for the youth, adult, and their communities.